Methods, program product, and systems for healthcare practice management

ABSTRACT

Methods, program product, and systems are provided for optimizing profits for healthcare practices and insurance networks. The methods, program product, and systems include modifying physician&#39;s cost management behavior to enhance profitability of healthcare practices and insurance networks by identifying physicians that are not profitable because of cost management behavior and providing intervention to change the management behavior of the physician.

RELATED APPLICATIONS

The application is a continuation of and claims priority to and thebenefit of U.S. patent application Ser. No. 09/812,704, titled “Methodsand System for Healthcare Practice Management,” filed Mar. 19, 2001,related to U.S. patent application Ser. No. 09/812,703 titled “MethodsFor Collecting Fees For Healthcare Management Group” filed Mar. 19,2001, which are each incorporated herein by reference in its entirety.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to the healthcare industry and, moreparticularly, to the field of healthcare management.

2. Description of Related Art

In the healthcare industry, as illustrated in FIG. 1, physiciansgenerally organize themselves into practice groups 25 and normallysubcontract to an insurance network 30. The insurance network 30 is notlimited to traditional insurance networks, i.e., Blue Cross Blue Shield,Aetna, United Healthcare, etc., but also include self insured networkswithin companies, employers, or other large entities. The insurancenetwork 30 includes a plurality of patients 35 that obtain healthcareservices from the plurality of physicians 25 participating in theinsurance network 30. The groups of physicians 25 include a plurality ofphysicians 25 that provide healthcare services to a plurality ofpatients 35 within a particular geographical area in varying medicalfields. The physicians in the healthcare practices 25 are normallycompensated a predetermined reimbursement amount by the insurancenetwork 30 for every subscribing patient 35 in the insurance network 30that is to be treated by the physicians 25.

For example, a physician 25 participating in the insurance network 30may be reimbursed $80 per month by the insurance network 30 for agreeingto treat a patient 35 in the insurance network 30 and assume theresponsibility for a percentage of the ancillary medical costs for thatpatient 25. As illustrated in FIG. 1, there exists a relationshipbetween the insurance network 30 and the physician practice 25.Likewise, there also exists a relationship between the patients 35 andthe insurance network 30, and the patients 35 and the physicianpractices 25. The physician practice 25 normally receives payment forservices directly from the patients 35 or through reimbursements fromthe insurance network 30. The payment that is received from the patient35 can be in the form of a co-payment or a partial payment for thehealthcare services. In order for the physician practice 25participating in the insurance network 30 to receive the entirereimbursement from the insurance network 30, i.e., the $80 per month foragreeing to treat each patient 35, the physician practice 25 must complywith preselected requirements set by the insurance network 30. Theserequirements often fall within varying cost centers, such aspharmaceutical, laboratory, anesthesiology, and radiation costs, forexample.

In the pharmaceutical area, for example, a wide variety of prescriptionmedications are developed and manufactured to combat similar illnesses.As illustrated in FIG. 1, prescription medication manufacturers 24sometimes enter into agreements with the insurance network 30. Theprescription medication manufacturers 24 sometimes offer rebates toinsurance networks 30 if the physician practice 25 prescribes theirmedications. The prescription medication manufacturers 24 cannot enterinto these types of agreements with the physician practices 25, as itwould likely be contrary to public policy. The insurance network 30, inturn may enter into an agreement with a pharmacy network 21, such as apharmacy benefits management (PBM), for example, to encourage thephysician practice 25 in the insurance network 30 to prescribe certainmedications. The PBM is compensated a profit on the preferredprescription medications, and a portion of the profits are then passedalong to the pharmacy 40. The requirements, or preferences, set by theinsurance network 30 regarding pharmaceutical costs, for example,include the types of prescription medications that the physicians mayprescribe to their patients.

In some instances, the insurance networks provide incentives to thephysician practice 25 for prescribing medications upon which, theinsurance network 30 receives discounts from prescription medicationmanufacturers 24. If the physician practice 25 bears any percentage ofmedication costs for the patient 35 and prescribe medications whichdiffer from those preferred by the insurance network 30, the incentivesmay be withheld from the physician practice 25, i.e., the physicianpractice 25 may be paid nothing instead of $10 for the patient 35 in theinsurance network 30. As illustrated in FIG. 1, the insurance network 30monitors the prescriptions that the physician practice 25 participatingin the insurance network 30 write through a monitoring relationshipdeveloped with pharmacies 40 and pharmacy networks 21. In thismonitoring relationship, the pharmacy 40 and the PBM provide claims datato the insurance network 30.

There are many different levels of risk for the physician practice 25that is associated with this arrangement. If the insurance network 30assumes the financial responsibility for the patient's 35 healthcareneeds, then the physician practice 25 assumes no risk. If, however, thephysician practice 25 assumes the financial responsibility for thepatient's healthcare needs, i.e., any healthcare costs beyond thereimbursement amount from the insurance network 30, then the physicianpractice 25 assumes the most risk. Another alternative arrangement is ifthe financial responsibility for the patient's 35 healthcare needs areshared between the physician practice 25 and the insurance network 30.In such an arrangement, the risk for patient's 35 healthcare costs isshared between the insurance network 30 and the physician practice 25.As illustrated in FIG. 1, the payments between the insurance network 30and the physician practice 25 can vary depending upon the amount of risktaken by the physician practice 25.

As further illustrated in FIG. 1, patients 35 participating in theinsurance network 30 obtain healthcare treatment from the physicianpractice 25 and pay premiums or insurance payments to the insurancenetwork 30. The medical treatment provided to the patients 35 by thephysicians in the physician practice 25 can include prescribingmedications. The patients 35, however, obtain the prescriptionmedications from the pharmacy 40 and provide either a full payment or aco-payment for the prescription medications. The patients 35 can then bereimbursed for some or all of the payment for the prescriptionmedications from the insurance network 30.

This arrangement is disadvantageous for the physician practice 25participating in the insurance network 30 because it requires a greatdeal of management and organization to follow the requirements of theinsurance network 30. The system is even more disadvantageous for thephysician practice 25 if it participates in multiple insurance networks30. Each insurance network 30 maintains a preferred list of prescriptionmedications, for example, that the physician practice 25 may prescribeto the patients 35. Further, each insurance network 30 updates theirpreferred list of prescription medications on a routine basis. Thephysician practice 25 in the insurance network 30 generally attempts tospend the majority of their time treating patients 35. The managementand organization of the insurance network 30 requirements can be timeconsuming and eliminate some of the time that a physician practice 25may normally dedicate to the treatment of patients 35.

Traditionally, there also has been tension between the physicianpractice 25 and the insurance network 30. The tension can be caused bythe insurance network 30 delaying payment to the physician practice 25with notification of a particular network requirement that has beenviolated, if any. In addition, the physician practice 25 normallyreceive very little support from the insurance network 30, such aspatient history updates and information on medication costs. Tensionsare also sometimes caused by the insurance network's 30 perception thatthe physician practice 25 over-bills for treatment and does not provideall possible treatment options for patients 35. The physician practice25 sometimes feel pressured by the insurance network 30 to providemedical treatment to their patients 35 according to the preferences ofthe insurance network 30 instead of according to their own medicaljudgments of course, the physician practice 25 is free to independentlytreat the patients 35 in the insurance network 30 based on medicaljudgment, but the tension between the physician practice 25 and theinsurance network 30 still exists.

The physician practice 25 is not bound by the treatment procedures thatare preferred by the insurance network 30. Often, however, conflictbetween the insurance network 30 and the physician practice 25 can arisewhen the insurance network 30 prefers the physician practice 25 toperform certain medical procedures or prescribe particular medicationsthat are more profitable to the insurance network 30. The physicianpractice 25 does not have the time necessary to perform exhaustiveresearch necessary to determine if the treatment proposed by theinsurance network 30 is feasible, or even safe, to patients 35. Prudentphysicians in the physician practice 25 often do not change theirtreatment practices based simply on information provided by theinsurance networks 30.

In the interest of patient safety, physicians in the physician practice25 should research medical literature to become more educated as topossible benefits of alternative medications. As noted above, however,this takes a great deal of time that can better be used to treatpatients 35. In order to conserve the time that might normally be spenton managing and organizing the insurance network 30 requirements,however, some physician practices 35 may hire office managers. This isdisadvantageous because an office manager can be extremely costly andwill normally need office space. The office space that may be used bythe proposed office manager may be an examination room in which thephysician would normally treat patients 35. Once again, this cuts downon the number of patients 35 that the physician practice 25 can possiblytreat. The office manager also often only manages finances and personneland has little understanding of physician practices 25 with respect torelationships between insurance networks 30 and physicians' 25 decisionsand practices with respect to patients 30.

It has been proposed that the performance of a first healthcare providercan be compared to the performance of a second healthcare provider usinga computer program as described in U.S. Pat. No. 5,652,842 titled“Analysis and Reporting of Performance of Service Providers”, bySiegrist, Jr. et al. More particularly, a method of monitoring customersatisfaction so as to keep the healthcare providers competitive in manydifferent fields is described. The method described in Siegrist, Jr. etal., however, is disadvantageous to group physicians in organizing andmanaging healthcare costs that are dependant upon preferred treatment ofthe insurance network.

When the physician practice 25 is not able to organize and managemedical treatment information in a manner that is preferred by theinsurance network 30 in which they participate, there only exist twopossible results. Either the physician practice 25 receives lowerreimbursements from the insurance network 30, or the insurance network30 is less profitable. No matter which result occurs, however, theultimate end result is higher medical costs for patients 35. Therefore,the patients 35 are the real losers in the situations described above.

SUMMARY OF THE INVENTION

With the foregoing in mind. Embodiments of the present inventionadvantageously provides a system and methods for managing a healthcarepractice which optimizes profits of the healthcare practice. The systemand methods of Embodiments of the present invention also advantageouslyassist physicians and insurance providers in providing cost-effectivehealthcare services to patients. The system and methods of managing thehealthcare practice of Embodiments of the present invention additionallyadvantageously eliminates the time necessary for physicians to conductexhaustive research in determining if alternative, and more profitable,ancillary medical procedures are beneficial to their patients. Thesystem and methods according to embodiments of the present inventionfurther advantageously assist in controlling the rising costs of medicalcare by reducing physicians' ancillary medical costs. The system andmethods according to embodiments of the present invention still furtheradvantageously strengthens the relationship between physicians andinsurance providers by providing an intermediary between the two.

More particularly, an embodiment of the present invention provides amethod of managing a healthcare practice participating in an insurancenetwork to optimize profitability of the healthcare practice withrespect to a predetermined reimbursement amount for selected ancillarymedical costs. The method advantageously includes gathering data fromeach of a plurality of physicians in the healthcare practiceparticipating in the insurance network regarding management of theselected ancillary medical costs. The method further includesidentifying at least one of the plurality of physicians in thehealthcare practice participating in the insurance network that is at agreater risk of not receiving the predetermined reimbursement amount forthe ancillary medical costs from the insurance network by engaging inancillary medical procedures that are detrimental to receiving thepredetermined reimbursement amount for the ancillary medical costs. Themethod also includes modifying the at least one physician's managementbehavior regarding the ancillary medical costs to substantially reducethe risk of not receiving the predetermined reimbursement amount for theancillary medical costs from the insurance network.

The step of identifying the at least one physician preferably includesanalyzing the ancillary medical costs of each of the plurality ofphysicians in the healthcare practice, calculating an average ancillarymedical cost per physician for the healthcare practice, and identifyingthe physician that has ancillary medical costs that are a predeterminedpercentage greater than the average ancillary medical cost per physicianfor the healthcare practice. The step of identifying the at least onephysician also advantageously includes identifying the physician havingthe highest ancillary medical costs in the healthcare practice. Theancillary medical costs can include any costs taken from the group ofpharmacy, radiology, laboratory, anesthesiology, occupational therapy,physical therapy, speech therapy, therapeutic radiology, operating room,emergency room costs or other cost centers as understood by thoseskilled in the art.

An embodiment of the present invention also provides a method ofoptimizing the profitability of an insurance network having a pluralityof physicians in a healthcare practice participating therein by managingancillary medical costs. The method includes the step of gathering datafrom each of the plurality of physicians in the healthcare practiceparticipating in the insurance network regarding management of ancillarymedical costs. The method also includes the step of modifying theplurality of physicians' in the healthcare practice management behaviorregarding ancillary medical costs that are not profitable for theinsurance network.

An embodiment of the present invention further provides a healthcaremanagement optimization system for a healthcare practice including aplurality of physicians participating in an insurance network. Thehealthcare management optimization system includes at least onedatabase. The at least one database can advantageously include a firstand a second database. The first database includes information regardingancillary medical procedures that are preferred by the insurance networkand the second database includes information regarding ancillary medicalcosts of each of the plurality of physicians participating in theinsurance network. The healthcare management optimization system furtherincludes an analyzer in communication with the first and seconddatabases for analyzing the data in the first and second databases andcomparing the ancillary medical procedures that are preferred by theinsurance network with the ancillary medical costs of the plurality ofphysicians participating in the insurance network to thereby identifyancillary medical costs that are not preferred by the insurance network.The healthcare management system still further includes managing meansresponsive to the analyzer for managing the ancillary medical costs tothereby modify the ancillary medical costs of the physicians in thehealthcare practice to be more profitable to the insurance network.

An embodiment of the present invention still further provides ahealthcare management optimization system for a healthcare practiceincluding a plurality of physicians participating in an insurancenetwork. The healthcare optimization network advantageously includes aserver having at least one database. The at least one database canadvantageously include first and second databases. The system furtherincludes a communications network positioned to be in communication withthe server, a plurality of computers positioned to be in communicationwith the communications network, each including a user interfaceresponsive to a user, an updater positioned on the server and responsiveto the user interface updating each of the plurality of physicians inthe healthcare practice of any changes in the management of ancillarymedical costs that are preferred by the insurance network, andrecommending means positioned on the server and responsive to the userinterface for recommending to each of the plurality of physiciansalternative ancillary medical procedures that are preferred by theinsurance network.

An embodiment of the present invention advantageously strengthens therelationship between insurance companies and physicians by providing anintermediary that provides information to make modifications toancillary medical treatment procedures to both the physicians and theinsurance network. The information provided by the intermediary includesscientific and medical research literature and advantageously eliminatesthe research time and costs necessary for the physicians and theinsurance networks to make informed decisions and recommendationsregarding patient care. The research necessary to make the informeddecisions is advantageously provided to the physicians and the insurancenetworks.

An embodiment of the present invention also advantageously provideseducational information regarding alternative ancillary medicalprocedures to patients that insist on a particular ancillary medicalprocedure, i.e., insist on a prescription for a brand name medication,so that the patient can also make a more informed decision as to theirtreatment. When the patient is made a part of the decision to modifymedical care, the patient is more likely to trust both the physician andthe insurance network. Therefore, Embodiments of the present inventionalso advantageously strengthens the relationship between the patients,physicians, and insurance network.

Embodiments of the present invention further advantageously decreasesphysicians' overall ancillary medical costs, thereby enhancing theprofitability of the physician practice groups and insurance networks.Increased savings attributed to ancillary medical costs canadvantageously be passed on to patients, thereby decreasing the cost ofmedical care and co-payments for prescription medications. Embodimentsof the present invention allows the patient in the healthcare system tobe the real winner.

BRIEF DESCRIPTION OF THE DRAWINGS

So that the manner in which the features and advantages of theinvention, as well as others which will become apparent, may beunderstood in more detail, a more particular description of theinvention briefly summarized above may be had by reference to theembodiments thereof which are illustrated in the appended drawings,which form a part of this specification. It is to be noted, however,that the drawings illustrate only various embodiments of the inventionand are therefore not to be considered limiting of the invention's scopeas it may include other effective embodiments as well.

FIG. 1 is a schematic view of a typical relationship between physicians,insurance networks, and patients according to the prior art;

FIG. 1A is a schematic view of a relationship between physicians,insurance networks, patients, and a healthcare consultation groupaccording to an embodiment of the present invention;

FIG. 2A is a flow chart describing the method of managing ancillarymedical costs for healthcare practices and insurance networks accordingto an embodiment of the present invention;

FIG. 2B is a flow chart describing the method of modifying ancillarymedical procedures according to an embodiment of the present invention;

FIG. 2C is a flow chart describing the method of educating physicians onthe benefits of alternative ancillary medical procedures according to anembodiment of the present invention;

FIG. 3 is a flow chart describing the method of managing ancillarymedical costs and optimizing profitability for an insurance networkaccording to an embodiment of the present invention;

FIG. 4 is a schematic view of a system for a healthcare practiceincluding a plurality of physicians participating in an insurancenetwork according to an embodiment of the present invention;

FIG. 5 is an environmental view of a physician accessing acommunications network through a user interface of a system for ahealthcare practice to obtain information regarding management ofancillary medical costs according to an embodiment of the presentinvention;

FIG. 6 is an environmental view of a physician researching aninformation card positioned in a patient's chart to determine if analternative ancillary medical procedure is appropriate according to anembodiment of the present invention; and

FIG. 6A is a front elevational view of an information card that can bepositioned in a patients chart according to an embodiment of the presentinvention.

DETAILED DESCRIPTION

The present invention will now be described more fully hereinafter withreference to the accompanying drawings which illustrate preferredembodiments of the invention. This invention may, however, be embodiedin many different forms and should not be construed as limited to theembodiments set forth herein. Rather, these embodiments are provided sothat this disclosure will be thorough and complete, and will fullyconvey the scope of the invention to those skilled in the art. Likenumbers refer to like elements throughout, the prime notation, if used,indicates similar elements in alternative embodiments.

FIGS. 1A-6A illustrate systems and methods of optimizing profitabilityof healthcare practices and insurance networks by managing ancillarymedical costs. As illustrated in FIG. 1A, Embodiments of the presentinvention preferably includes a healthcare consultation group 22 thatforms an intermediary relationship between a healthcare practice 25 andan insurance network 30. The healthcare practice 25 preferably includesa plurality of physicians 27 practicing in one or more medical fields ina particular geographic area. The healthcare consultation group 22determines the most efficient manner to manage ancillary medical coststo thereby increase profitability of the healthcare practice 25 and theinsurance network 30 by decreasing ancillary medical costs. In caseswhere the financial responsibility for patient care is divided betweenthe insurance network 30 and the healthcare practice 25, the healthcareconsultation group 22 can also advantageously manage ancillary medicalcosts of the insurance network 30 and the healthcare practice 25 tothereby decrease ancillary medical costs, thereby increasingprofitability of both the insurance network 30 and the healthcarepractice 25. Ancillary medical costs can include pharmacy costs, forexample. The ancillary medical costs can also advantageously include anyone of a number of medical cost centers such as taken fromfederally-defined hospital departments. These can include, but are notlimited to, anesthesiology, blood, blood storage procedure andadministration, radiology, electroencephalogram (EEG), electrocardiogram(EKG), emergency room, IV therapy, organ and tissue acquisition, laborand delivery, medical/surgical supplies, nuclear medicine, occupationaltherapy, operating room, physical therapy, recovery room, renaldialysis, respiratory therapy, special care, speech therapy, andtherapeutic radiology. These general categories also can be broken downinto more specific categories as understood by those skilled in the art.

As perhaps best illustrated in FIGS. 1A-4, Embodiments of the presentinvention provide methods for managing a healthcare practice 25 tooptimize the profitability of the healthcare practice 25 by decreasingthe healthcare costs of the healthcare practice 25. As illustrated inFIG. 3, Embodiments of the present invention also provide methods ofoptimizing the profitability of an insurance network 30 having aplurality of physicians 27 in a healthcare practice 25 participatingtherein by managing ancillary medical costs, i.e., pharmacy costs, ofthe healthcare practice 25, or a combination of the healthcare practice25 and the insurance network 30. Embodiments of the present inventionare particularly advantageous for use in association with pharmacy costbecause of the large year to year increases in the cost of prescriptionmedications and other pharmaceutical related costs. The method ofmanaging the healthcare practice 25 and the method of optimizing theprofitability of the insurance network 30 includes gathering data 50from each of the plurality of physicians 27 in the healthcare practice25 participating in the insurance network 30 regarding management ofancillary medical costs. The step of gathering of data 50 preferablyincludes conferring with the healthcare practice 25 and the insurancenetwork 30 to determine 53 the number of patients 35 participating inthe insurance network 30 and the current ancillary medical procedureused to treat those patients 35. In a case where the ancillary medicalcost is pharmacy cost, for example, the method includes gathering datafrom the physicians 27 regarding the number of pharmacy claims over apredetermined period of time, the number of patients 35 treated by thephysician 27, and demographic information about the physician 27.

Data is also gathered 52 from ancillary medical facilities 40 regardingancillary medical costs of each of the plurality of physicians 27 in thehealthcare practice 25 participating in the insurance network 30. Thisdata can advantageously include claims information, claim types and costdata regarding the claims. This data can also advantageously be gatheredfrom the healthcare practice 25 or the insurance network 30. The datacollected from the ancillary medical facilities 40 can be available onan ancillary medical network database, such as a pharmacy networklisting pharmacy costs for each of a plurality of physicians 27 in thehealthcare practice 25. Again, in a case where the ancillary medicalcost is pharmacy cost, for example, the method of gathering data 50includes obtaining average wholesale pharmacy costs from pharmacynetworks such as First Databank, Red Book, and Blue Book, for example,or any other pharmacy network as understood by those skilled in the art.The step of gathering data 50 from the pharmacy also includes gettingmonthly updates from the pharmacy network regarding average wholesalepharmacy costs. The step of gathering data 50 further preferablyincludes extrapolating a contracted price of prescription medicationsfrom the pharmacy claims data.

If the ancillary medical cost is pharmacy cost, for example, then thestep of gathering data 50 can advantageously include preparing amanagement report that includes information regarding the physician'spharmacy cost performance measured by per member per month (PMPM) costs.The management report can also advantageously include a physician reportcard to inform the physician 27 of current performance and high costpatient reports from the physician 27. The report card is advantageouslydetailed for each physician 27 based on prescribing patterns, costs ofmanagement behavior to them and the healthcare practice 25,peer-reviewed alternative prescription medications, and potentialsavings if followed. The report cards are then presented to theidentified physician 27 so that they can perform their own analysis. Thehealthcare practice 25 can advantageously encourage the physician 27 togive the report consideration. The management report can alsoadvantageously include a list of the top medication providers, e.g., thetop fifty high-cost prescription medication providers and a pharmacycost management report.

The method of managing the healthcare practice 25 and the method ofoptimizing the profitability of an insurance network both furtherpreferably include identifying 56 at least one physician 27 in thehealthcare practice 25 that is engaging in ancillary medical proceduresthat are not as profitable or preferred by the insurance network 30.Physicians 27 who engage in the ancillary medical procedures that arenot preferred by the insurance network 30 are sometimes at risk of notreceiving a predetermined reimbursement amount from the insurancenetwork 30. These ancillary medical procedures can include theprescription of medications that are not as profitable to the insurancenetwork 30 or the physicians 27 in the healthcare practice 25. In caseswhere the financial responsibility for patient 35 care is shared betweenthe healthcare practice 25 and the insurance network 30, then theprofitability of both the insurance network 30, and the healthcarepractice 25 are enhanced. Typically, alternative medications areavailable that combat the same illnesses. In some instances, however,either the physician is not familiar with the alternative medication orthe patient 35 insists on a particular brand-name medication merelybecause the brand-name medication has been greatly advertised, marketed,or commercialized.

The step of identifying the at least one physician 56 preferablyincludes analyzing the data 58 collected from the physicians and theancillary medical network databases to determine the ancillary medicalcosts of each physician 27 in the healthcare practice 25. The step ofidentifying the at least one physician 56 also preferably includescalculating 60 an average ancillary medical cost per physician in thehealthcare practice 25. After an average is calculated 60, physicians 27having ancillary medical costs that fall a predetermined standarddeviation away from the average, e.g., two standard deviations from theaverage of their peers in the healthcare practice 25, are identified 56and targeted for intervention. Should a point be reached where nophysician 27 falls beyond the two standard deviation limit, then apredetermined percentage of the physicians having the highest or higherthan average ancillary medical costs will be considered forintervention.

The method of managing the healthcare practice group 20 and optimizingthe profitability of an insurance network 30 both further includeidentifying patients 35 and ancillary medical procedures that have costsabove the average ancillary medical cost calculated above. For example,the step of identifying patients 35 whose ancillary medical costs aregreater than the average ancillary medical costs per physician 27 caninclude identifying patients 35 who have pharmacy costs greater than theaverage pharmacy cost of the physician 27. Another example preferablyincludes identifying prescription medications having a higher cost thanthe average prescription medication cost of the healthcare practice 25.

When the physician 27 that has ancillary medical costs greater than theaverage ancillary medical costs of the healthcare practice 25 isidentified, the method of managing the healthcare practice group 20 andoptimizing the profitability of an insurance network 30 both fartherinclude conferencing with the identified physician 27 to discuss theimpact of not taking any action regarding ancillary medical costoverruns.

The method of managing the healthcare practice 20 and the method ofoptimizing the profitability of an insurance network 30 both furtherinclude modifying the physician's management behavior 65 regarding theancillary medical costs. The physician's management behavior is modifiedto advantageously reduce the risk of not collecting the predeterminedreimbursement amount from the insurance network 30 to thereby increasethe physician's profitability. The physiciants modified managementbehavior can also advantageously increase the profitability of theinsurance network 30.

The step of modifying the physicians management behavior includeseducating 70 the at least one physician 27 on benefits of alternativeancillary medical procedures. The education 70 of the physician 27 canbe performed using research literature for comparing the alternativeancillary medical procedures to current ancillary medical procedures.The education 70 can further include organizing continued medicaleducation classes 71 through ancillary medical facilities and can alsoinclude the education 72 of nurses and ancillary staff members. This isadvantageous because continued medical education classes are generallyrequired in order for a physician 27 to keep licensing requirementscurrent. The continued medical education can advantageously fulfill thephysician's licensing requirement while simultaneously educating thephysician 27 as to the benefits of alternative ancillary medicalprocedures that may be more advantageous to themselves as well as totheir patients.

The step of educating 70 the at least one physician advantageouslyincludes providing the at least one physician national treatmentguidelines for stepwise treatment of disease states. Too oftenprescription medication representatives, such as sales representatives,convince physicians 27 that the newest medication is necessary to treatpatients 35 and other regimens should be skipped or abandoned. The stepof educating 70 the physicians 27, therefore, includes recommending thatphysicians 27 follow nationally recognized guidelines and treatmentprotocols, such as from the Center for Disease Control (CDC) and theNational Institute of Health (NIH), for example.

This advantageously ensures that community accepted standards of careare being provided. The step of educating 70 the physicians 27 alsoadvantageously includes identifying the medications of choice for givendisease states and verify, through data analysis and dialog that medicalresearch indicates that modified physicians behavior will have afavorable impact. The step of educating 70 the physicians 27 usingpeer-reviewed, medical research based literature recommending nationallyrecognized guidelines also advantageously decreases liability incurredby physicians 27. The physicians' 27 medical malpractice liability canadvantageously be decreased if the physician follows nationallyrecognized guidelines and treatment protocols.

The step of modifying the physician's management behavior also includesproviding patient history updates. If, for example, the physician 27makes a decision to modify a patient^(t)s 35 prescription medication inthe interest of decreasing pharmacy cost, for example, the patienthistory updates become very advantageous for the general safety andwelfare of the patient 27. At the time of ordering the new prescription,physicians 27 may not have all the patient's 35 medical history toprescribe a medication without inducing an adverse drug reaction (ADR).ADR's often lead to increased repeat visits to the physician 27 for thesame ailment and possibly to a hospital, which increase the healthcarepractice's 25 health care cost tremendously. After the gathered data,provided by a pharmacy benefits management (PBM) company or a pharmacyclaims benefit administrator, for example, is analyzed, printouts of thepatients' 35 prescription history can advantageously be provided to thephysician 27. These printouts may be included in patient 35 charts forup-to-date reference by the physicians 27.

As best illustrated in FIG. 2A, the method of managing the healthcarepractice 25 and the method of optimizing profitability of the insurancenetwork 30 further includes providing a list of ancillary medicalprocedures, e.g., a list of preferred prescription medications, that arepreferred by the insurance network 30. If the physicians 27 follow thesuggested ancillary medical procedure list, the physicians 27 are morelikely to receive the predetermined reimbursement from the insurancenetwork 30, thereby providing enhanced profits to the physicians 27 aswell as to the insurance networks 30. The enhanced profitabilityadvantageously allows the insurance network 30 and the physicians 27 toprovide more cost-effective medical treatment to the patients.

As also illustrated in FIG. 2A, the methods of managing the healthcarepractice 25 and optimizing profitability of the insurance network 30also advantageously include providing custom ancillary medicationprocedure forms 75, i.e., custom prescription medication pads, for useby the physician 27 to easily recognize which ancillary medicalprocedures are preferred by the insurance network 30. For example, thephysician 27 is provided a custom prescription medication pad 75 thatincludes a vast list of prescription medications that are preferred bythe insurance network 30. This eliminates the time necessary for thephysician 27 to perform research on which medications are preferred bythe insurance network 30.

Physicians 27 sometimes participate in a number of insurance networks30. Differing insurance networks 30 normally have differing preferredancillary medical procedures. When the physicians 27 participate indiffering insurance networks 30, it becomes difficult to determine whichancillary medical procedures are preferred by each of the differentinsurance networks 30. The various insurance networks 30 normally haveoverlapping ancillary medical procedures. Therefore, the step ofproviding custom ancillary medical procedure customization forms alsoincludes the step of providing custom ancillary medical procedure formsthat account for the overlapping ancillary medical procedures of thevarious networks and advantageously eliminate the need for the physician27 to take the time to research what insurance network 30 the patient 35participates in and which ancillary medical procedures are preferred bythe particular insurance network 30 in which the patient 35participates. The custom ancillary medical form that accounts foroverlapping ancillary medical procedures between various insurancenetworks 30 advantageously allows the physician 27 to engage in anyancillary medical procedure that is listed on the form without any riskof not receiving the predetermined reimbursement amount from theinsurance network 30.

As best illustrated in FIG. 2A-2C the methods of managing a healthcarepractice 25 and optimizing profitability of an insurance network 30according to an embodiment of the present invention also includesproviding patient intervention 80 to enhance the profitability of thephysicians 27 and the insurance networks 30. One source of increasedancillary medical costs are unnecessary patient requests. The patients35 sometimes request particular ancillary medical procedures because ofa lack of knowledge regarding alternative ancillary medical procedures.For example, some patients 35 insist on brand-name medications that arelargely commercialized without having the requisite knowledge to make aninformed decision regarding alternative ancillary medications. The stepof providing patient intervention 80 advantageously includes identifying56 the patients who participate in ancillary medical procedures that arenot preferred by the insurance network 30 and put the physician 27 atrisk of not receiving a predetermined reimbursement from the insurancenetwork 30. The method of providing the patient intervention 80 alsoadvantageously includes discontinuing the current ancillary medicalprocedure and amending it with a new ancillary medical procedure that ispreferred by the insurance network 30 and reduces the risk of thephysician 27 not receiving the predetermined reimbursement amount fromthe insurance network 30.

The step of providing patient intervention can advantageously includecontacting patients 35 that are affected by poly-pharmacy andnon-compliance, for example. The step of contacting patients includescontacting the patients 35 on a monthly basis. Poly-pharmacy occurs whenthe patient 35 is taking medications with ADR's, unnecessarymedications, or those from the same medication class. In addition, if itis discovered during the step of analyzing the gathered data that thepatient 35 is not taking the prescription medication as required, thestep further includes contacting the patient 35 with a directive tocomply with the treatment protocols. The contact to the patient 35 can,for example, be made in the form of a letter written on the physician's27 letterhead.

The step of providing patient intervention also advantageously includesdetermining if stronger disease state management techniques arerequired. This determination is conducted on a monthly basis. For thosepatients 35 with aggressive diseases, specialist organizations areemployed to provide recommendations to the physicians 27 and thepatients 35 on the latest treatments techniques.

The steps of discontinuing and amending current ancillary medicalprocedures includes providing information to the patients 35 regardingthe benefits of the new alternative medical procedure, e.g., informationthat a lay-patient can understand regarding the benefits of analternative prescription medication. The step of providing patientintervention also includes providing a monthly review of patient'scharts to determine if the new ancillary medical procedures aresufficient for the patient's treatment. As patients are identified 56that are not being treated per guidelines of alternative ancillarymedical procedures, a chart 48 is advantageously inserted into apatient's medical chart, recommending an alternative ancillary medicalprocedure. The chart insert 48 advantageously includes an explanation ofthe recommended and pre-written ancillary medical procedure orders,i.e., pre-written prescriptions, for the physician's approval.

The physicians 27, however, do not always yield to the preferredancillary medical procedures of the insurance network 30. When thephysicians 27 encounter a situation where, relying on their vast medicalknowledge, they know a proposed ancillary medical procedure isdetrimental to the patient 35, then the insurance network 30 isapproached to consider modifying their preferred ancillary medicalprocedures. Like the physicians 27, the insurance network 30 is educatedregarding the benefits of the ancillary medical procedure that they seekto modify. This advantageously levels the playing field betweenphysicians 27 and insurance networks 30. Embodiments of the presentinvention provides for the possibility that the insurance network 30will yield to the medical judgment of the physician 27 concerning thetreatment of patients 35.

The step of discontinuing an ancillary medical procedure furtherincludes the step of preparing a plurality of letters 86. The step ofpreparing letters includes the healthcare consultation group 22obtaining permission 84 from the physician 27 to distribute letters 87to the patients 35 that are candidates for modification of ancillarymedical procedures. One of the plurality of letters informs theancillary medical facility of the discontinuation of a particularancillary medical procedure 88. Another of the plurality of lettersinforms the patient that a particular ancillary medical procedure isdiscontinued 87. The letters can advantageously be written on thephysician's letterhead. The letter to be sent to the patient 35advantageously includes a detailed explanation of why the ancillarymedical procedure is being modified, the benefits of the new ancillarymedical procedure, and the advantages that patient 35 will obtain fromusing the new ancillary medical procedures. The letter to be sent to theancillary medical facility 88 instructs the ancillary medical facilitythat the ancillary medical procedure is discontinued and can alsoadvantageously inform the ancillary medical facility of an amendment tothe ancillary medical procedure. The step of discontinuing the ancillarymedication also includes providing the physician 27 with a list of“frequently asked questions and answers” so that the physician 27 isprepared for what may be difficult questions posed by the patients 35.This advantageously allows the physician 27 to give the patients 35clear and concise answers that do not make the patient 35 feel as thoughthe physician 27 and the insurance network 30 are taking advantage ofthe patient.

The step of providing patient intervention also advantageously includesordering a new alternative ancillary medical procedure upon a newdiagnosis 83. The step of ordering a new ancillary medical procedureadvantageously includes providing a monthly update 90 to the physicians27 regarding new alternative ancillary medical procedures. The monthlyupdates can come in the form of a newsletter, for example. The step ofordering a new ancillary medical procedure also advantageously includesproviding a review 91 between the physician 27 and the healthcareconsultation group 25 regarding new ancillary medical procedures andeducation 92 provided to the physicians 27 and patients 35 regarding thenew ancillary medical procedures. The patient's chart is periodicallyreviewed 93 to ensure that the new ancillary medical procedure iseffective and treatment guidelines are provided 94 on a chart insert 48,as illustrated in FIG. 6A.

The methods of managing the healthcare practice 25 and optimizing theprofitability of the insurance network 30 also advantageously includesupdating physicians 27 regarding changes of ancillary medical procedurespreferred by the insurance network 30. The step of updating canadvantageously include mailing the updated changes to each of thephysicians 27 in the healthcare provider group 22 using a newsletter 90,or can advantageously include transmitting the changes to the physicians27 via electronic mail or flyers, or other types of updates. The step ofupdating can also advantageously include connecting to a communicationsnetwork 100 where to access the updated information. This advantageouslyeliminates the time necessary for the physicians 27 to research newpreferred ancillary medical procedures. The updates are also a form ofcontinuing education for the physician 27 to learn of new techniques andmedications that are available to enhance the treatment of the patients35.

Some healthcare practices 25 have opted to use personal digitalassistants (PDAs) or other electronic data entry and retrieval hardwarein their practices. For those groups, whenever possible, the hardwareand/or software will be integrated with the information and servicesprovided as described above, Allscripts, Parkstone, and Realtime Rx arejust a few examples of companies that sell or lease such equipment. Thiswill be done in an effort to disencumber the physicians 27 so they canfocus on better management of their time.

As best illustrated in FIGS. 1A, 4, and 5, an embodiment of the presentinvention advantageously includes a healthcare management optimizationsystem 20 for a healthcare practice 25 including a plurality ofphysicians 27 participating in an insurance network 30. The system canadvantageously include a server 102 with a database 103 and acommunications network 100. The system 20 also preferably includes aplurality of computers 108 positioned to be in communication with thecommunications network 100, each including a user interface responsiveto a user U. The database 103 can advantageously include first andsecond databases. The first database includes information regardingpreferred ancillary medical procedures of an insurance network. Thesecond database includes ancillary medical costs of a plurality ofphysicians 27 participating in the insurance network 30. The systemfurther includes an updater positioned on the server 102 and responsiveto the user interface for updating each of the plurality of physicians27 on any changes of preferred ancillary medical procedures preferred bythe insurance network 30.

The system 20 of an embodiment of the present invention also includes ananalyzer such as provided by software programs stored on a computer orprocessor as understood by those skilled in the art positioned on theserver 102 and in communication with the first and second databases forcomparing the ancillary medical procedures that are preferred by theinsurance network 30 with the ancillary medical costs of the pluralityof physicians 27 participating in the insurance network 30. The analyzeradvantageously identifies ancillary medical costs of the physicians 27that are not preferred by the insurance network 30. The analyzer furtherincludes calculating means for calculating an average ancillary medicalcost per physician 27 for the healthcare practice 25. The averageancillary medical cost is used to identify the physicians 27 that are inneed of assistance to reduce the risk of not receiving the predeterminedreimbursement amount for ancillary medical costs from the insurancenetwork 30.

The system 20 still farther includes recommending means, e.g., providedby software as understood by those skilled in the art, positioned on theserver 102 and responsive to the user interface for recommending to eachof the plurality of physicians 27 alternative ancillary medicalprocedures that are preferred by the insurance network 30. Therecommending means can advantageously be provided by software thatresides on the server 102. The system also preferably includes managingmeans, e.g., provided by software as understood by those skilled in theart, for managing ancillary medical cost management behavior of thephysicians 27. The managing means can advantageously be provided bysoftware that resides on the server 102. The managing means preferablyincludes a modifier to modify the management behavior of the physicians27 so that the physicians 27 engage in ancillary medical procedures thatare preferred by the insurance network 30. The managing means alsoincludes an identifier for identifying at least one of the plurality ofphysicians 27 in the healthcare practice 25 participating in theinsurance network 30 that is at a greater risk of not receiving apredetermined reimbursement amount for the ancillary medical costs fromthe insurance network 30 because of engagement in ancillary medicalprocedures that are not as profitable to the insurance network 30.

The system 20 of an embodiment of the present invention still furtherincludes patient intervening means, e.g., provided by software asunderstood by those skilled in the art, for identifying at least onepatient 35 whose present ancillary medical procedures are not preferredby the insurance network 30. The patient intervening means canadvantageously be provided by software that resides on the server 102.The management means of the system 20 further includes generating means,e.g., also preferably provided by software as understood by thoseskilled in the art, for generating a plurality of letters to modify theancillary medical procedures of the physician 27. The letters includefirst and second letters. The first letter informs the ancillary medicalfacility that the patient's 35 present ancillary medical procedure ismodified. The second letter is sent to the patient 35 to inform thepatient of the new ancillary medical procedure. The second letterincludes educational information informing the patient 35 of thebenefits of the new ancillary medical procedure and educationalmaterials that may answer any questions that the patient 27 may have.

As illustrated in FIG. 3, an embodiment of the present invention alsoprovides methods of collecting fees 120 for managing and optimizing theprofitability of a plurality of physicians 27 in a healthcare practice25 and for managing and optimizing the profitability of an insurancenetwork 30. The method includes establishing a relationship 122 betweena healthcare consultation group 22, a plurality of physicians 27 in ahealthcare practice 25, and an insurance network 30. This advantageouslyprovides a team working towards a common goal, ice., a team workingtowards the goal of enhancing profitability through better and morecost-effective healthcare. The newly established relationship can beused to modify the physicians' ancillary medical cost managementbehavior to enhance the profitability of the insurance network 30 and toreduce the physician's 27 risk of not receiving a predeterminedreimbursement amount for ancillary medical costs from the insurancenetwork 30.

The method of collecting fees 120 can advantageously include the step ofthe healthcare consultation group 22 funding an incentive pool 124 to bepaid to the healthcare practice 25, or to the insurance network 30,depending upon who hires the healthcare consultation group 22. Thehealthcare consultation group 22 only collects a fee if their servicesto the healthcare practice 25 and the insurance network 30 aresuccessful. Therefore, the fees are only collected on a success-feebasis. In some cases, however, a nominal fee may be charged by thehealthcare consultation group 22 before services are performed. Themeasure of success of the services of the healthcare consultation group22 is a decrease in healthcare costs of the insurance network 30 and thephysicians 27 in the healthcare practice 25 for specific ancillarymedical costs. If services of the healthcare consultation group 22,however, do not decrease healthcare costs for the plurality ofphysicians 27 or the insurance network 30 below a predetermined levelover a preselected period of time, the funds in the incentive pool areturned over to the healthcare practice 25 or the insurance network 30,depending on who is the healthcare consultations group 22 client. Thisadvantageously provides accountability to the healthcare consultationgroup 22. Accountability will ease the minds of the healthcare practice25 and insurance network 30 giving the healthcare consultation group 22a chance to prove that profits can be enhanced.

The method of collecting fees 120 further includes distributingpredetermined percentages 126 of savings attributed to the services ofthe healthcare consultation group 22. As illustrated in FIG. 3, thesavings are distributed to the healthcare practice Y, the healthcareconsultation group Z and the insurance network X. For example, thepercentages can be 40% to the consultation group. Clearly thesepercentages can vary depending on the client of the consulting group andan agreement between the parties. This arrangement advantageously allowsall involved to gain, including patients, through more cost-effectivemedical care. The predetermined percentage that is distributed to thehealthcare practice Y can advantageously be further distributed 128 inpredetermined percentages evenly to the healthcare practice 25 orallocated proportionately according to the savings of each of theplurality of physicians 27 in the healthcare practice 25.

The step of distributing predetermined percentages 126 of savingsattributed to the services of the healthcare consultation group 22 canadvantageously vary depending on whether the client of the healthcareconsultation group 22 is the healthcare practice 25 or the insurancenetwork 30. The distributed percentages can advantageously be equalbetween the healthcare consultation group 22, the insurance network 30,and the healthcare practice 25. If, for example, the client of thehealthcare consultation group 22 is the healthcare practice 25, then thepredetermined percentages distributed to the healthcare consultationgroup 22 and the healthcare practice 25 can be greater than thepredetermined percentage of the savings that are distributed to theinsurance network 30, e.g., the insurance network 30 may not collect anypercentage of the savings. If, however, the client of the healthcareconsultation group 22 is the insurance network 30, then thepredetermined percentages distributed to the healthcare consultationgroup 22 and the insurance network 30 can be greater than thepredetermined percentage of the savings that are distributed to thehealthcare practice 25.

The method of collecting fees can also advantageously include a pricing,billing, or charging structure. The pricing structure of the healthcareconsultation group 22 is straight forward. The clients, i.e., thehealthcare practice 25 or the insurance network 30, measure theirancillary medical costs, or pharmacy costs for example, on a per-memberper-month (PMPM) basis. During a pharmacy assessment, an average PMPMpharmacy cost (baseline PMPM) is calculated using the clients past sixmonths pharmacy claims and membership data. Each month, the currentmonths average PMPM pharmacy cost is subtracted from baseline PMPM inorder to determine the savings realized from the healthcare consultationgroup's 22 services.

A commission fee can advantageously be calculated on predeterminedpercentage of the monthly client savings, e.g., 50% of monthly savings,multiplied by the number of patients each month. For example, asustained $1.00 PMPM savings for client with 30,000 covered lives wouldyield to the healthcare consultation group 22 $15,000 per month, for upthe duration of the contract. The contract can span between one andthree years, for example, or can have a longer duration. The healthcareconsultation group 22 can collect a smaller fee percentage for longercontract durations. If the client desires a longer contract duration,the baseline PMPM can advantageously be increased yearly with respect toannual inflation increases of wholesale prescription medication costs.The risk reversal for the client is that if there is no savings anymonth, the client pays nothing.

The pricing structure can also advantageously include a referralcommission, e.g., $0.25, for each covered life, or a percentage of theclient's savings for example, provided to the strategic marketingpartners. This referral commission compensates for the commissions aidto sales people and people who refer business to the healthcareconsultation group 22. Thus, the healthcare consultation group 22minimizes the marketing budget while advantageously maximizing marketingresults.

The application is related to U.S. patent application Ser. No.09/812,704, titled “Methods and System for Healthcare PracticeManagement,” filed Mar. 19, 2001, and to U.S. patent application Ser.No. 09/812,703 titled “Methods For Collecting Fees For HealthcareManagement Group” filed Mar. 19, 2001, which are each incorporatedherein by reference in its entirety.

In the drawings and specification, there have been disclosed a typicalpreferred embodiment of the invention, and although specific terms areemployed, the terms are used in a descriptive sense only and not forpurposes of limitation. The invention has been described in considerabledetail with specific reference to these illustrated embodiments. It willbe apparent, however, that various modifications and changes can be madewithin the spirit and scope of the invention as described in theforegoing specification and as defined in the appended claims.

1. A method of managing an outpatient healthcare practice participatingin an insurance network, the method comprising the steps of: analyzingdata from each of a plurality of physicians in the healthcare practiceparticipating in the insurance network including ancillary medicalcosts; identifying responsive to the analysis at least one of theplurality of physicians in the healthcare practice participating in theinsurance network that is at risk of not receiving the predeterminedreimbursement amount for the ancillary medical costs from the insurancenetwork by engaging in medical procedures other than those attributeddirectly to a medical procedure performed by a physician and that aredetrimental to receiving the predetermined reimbursement amount for theancillary medical costs; modifying management behavior of the at leastone of the plurality of physicians at risk regarding the ancillarymedical costs responsive to the identifying; and determining that therisk of not receiving the predetermined reimbursement amount for theancillary medical costs from the insurance network has been reducedresponsive to the modifying to increase the profitability of thehealthcare practice.
 2. A method as defined in claim 1, wherein the stepof identifying the at least one physician comprises analyzing theancillary medical costs of each of the plurality of physicians in thehealthcare practice, calculating an average ancillary medical cost perphysician for the healthcare practice, and identifying the physiciansthat have ancillary medical costs that are a predetermined percentagegreater than the average ancillary medical cost per physician for thehealthcare practice.
 3. A method as defined in claim 1, wherein the stepof identifying the at least one physician comprises selecting thephysician having the highest ancillary medical costs within thehealthcare practice.
 4. A method as defined in claim 3, wherein the stepof modifying management behavior of the at least one physician farthercomprises: preparing a list of ancillary medical procedures that the atleast one physician may engage in that enable the at least one physicianto receiving the predetermined reimbursement amount for the ancillarymedical costs; and providing custom medical procedure forms that includethe list of ancillary medical procedures to thereby define customancillary medical procedure forms and that the at least one physicianshould engage in to further enable the at least one physician to receivethe predetermined reimbursement amount for the ancillary medical costs.5. A method as defined in claim 1, wherein the insurance networkcomprises one of the plurality of insurance networks, the at least onephysician participates in the plurality of insurance networks; andwherein the step of modifying management behavior of the at least onephysician further comprises preparing a list of common ancillary medicalprocedures that are approved by each of the plurality of insurancenetworks so as to enable the at least one physician to receive thepredetermined reimbursement amount for the ancillary medical costs.
 6. Amethod as defined in claim 5, further comprising providing patientintervention to modify the at least one physician's management behavior,the patient intervention including identifying at least one patientwhose present ancillary medical procedures put the at least onephysician at risk for not receiving the predetermined reimbursements forthe ancillary medical costs, amending the at least one patient's presentancillary medical procedures to decrease the at least one physician'srisk of not receiving the predetermined reimbursements for the ancillarymedical costs, and discontinuing the at least one patient's presentancillary medical procedures that put the at least one physician at riskfor not receiving the predetermined reimbursements for the ancillarymedical costs.
 7. A method as defined in claim 1, wherein the ancillarymedical costs comprise pharmacy costs being other than those attributedby a medical procedure performed directly by any of the plurality ofphysicians when the respective physician directly administers amedication to a patient to thereby define ancillary pharmacy costs.
 8. Amethod as defined in claim 7, wherein the step of modifying managementbehavior of the at least one physician comprises educating the at leastone physician on the benefits of alternative prescription medicationsusing research literature for comparing the alternative medications tothe prescribed medications and organizing continued medical educationclasses to educate each of the plurality of physicians in the healthcarepractice on the benefits of the alternative prescription medications. 9.A method as defined in claim 8, wherein the step of modifying managementbehavior of the at least one physician further comprises: preparing alist of prescription medications that the at least one physician mayprescribe that enable the at least one physician to receive thepredetermined reimbursement amount for the ancillary pharmacy costs; andproviding custom prescription medication forms that include the list ofprescription medications that the at least one physician may prescribethat enable the at least one physician to receive the predeterminedreimbursement amount for the ancillary pharmacy costs.
 10. A method asdefined in claim 9, further comprising providing patient intervention tomodify the at least one physician's management behavior, the patientintervention including identifying at least one patient whose presentprescription medications put the at least one physician at risk for notreceiving the predetermined reimbursements for the ancillary pharmacycosts, amending the at least one patient's present prescriptionmedications to decrease the at least one physician's risk of notreceiving the predetermined reimbursements for the ancillary pharmacycosts, and discontinuing the at least one patient's present prescriptionmedications that put the at least one physician at risk for notreceiving the predetermined reimbursements for the ancillary pharmacycosts.
 11. A method of optimizing the profitability of an insurancenetwork having a plurality of physicians in a healthcare practiceparticipating therein by managing ancillary medical costs, the methodcomprising the steps of: analyzing data from each of the plurality ofphysicians in the healthcare practice participating in the insurancenetwork including management of medical costs other than thoseattributed directly to medical procedures performed by any of theplurality of physicians to thereby define ancillary medical costs;identifying responsive to the analysis at least one of the plurality ofphysicians in the healthcare practice participating in the insurancenetwork that is at risk of not receiving a predetermined reimbursementamount for the ancillary medical costs from the insurance network byperforming activities that are detrimental to receiving thepredetermined reimbursement amount for the ancillary medical costs;modifying management behavior of the at least one of the plurality ofphysicians in the healthcare practice regarding ancillary medical coststhat are not profitable for the insurance network responsive to theidentifying; and providing a financial incentive to the insurancenetwork and the plurality of physicians in the healthcare practiceparticipating in the insurance network to modify the plurality ofphysicians' management behavior of ancillary medical costs that are notas profitable to the insurance network.
 12. A method as defined in claim11, wherein the step of modifying management behavior of the at leastone of the plurality of physicians further comprises providing custommedical procedure forms that include the list of the ancillary medicalprocedures to thereby define custom ancillary medical procedure formsand that the plurality of physicians should engage in that are moreprofitable to the insurance network.
 13. Computer executable programproduct for managing a healthcare practice including a plurality ofphysicians and participating in an insurance network, stored on atangible computer medium, comprising: an analyzer in communication withat least one database for analyzing data in the at least one databaseand comparing ancillary medical procedures that are preferred by theinsurance network with the ancillary medical costs of the plurality ofphysicians participating in the insurance network to thereby identifyancillary medical costs of the physicians that are not preferred by theinsurance network; and managing means responsive to the analyzer formanaging the ancillary medical costs of the healthcare practiceidentified as not being preferred by the insurance network to therebymodify the ancillary medical costs of the physicians in the healthcarepractice to be more profitable to the insurance network, the managingmeans including an identifier for identifying responsive to the analyzerat least one of the plurality of physicians in the healthcare practiceparticipating in the insurance network that is at a greater risk of notreceiving a predetermined reimbursement amount for the ancillary medicalcosts from the insurance network by engaging in ancillary medicalprocedures that are detrimental to receiving the predeterminedreimbursement amount for the ancillary medical costs, and a modifierresponsive to the identifier for modifying ancillary medical costsmanagement behavior of the at least one of the plurality of physiciansat the greater risk regarding the ancillary medical costs, the managingmeans further determining responsive to the modifier that the risk ofnot receiving the predetermined reimbursement amount for the ancillarymedical costs from the insurance network has been reduced.
 14. Computerexecutable program product as defined in claim 13, wherein the at leastone database includes a first database comprising medical proceduresother than those performed directly by any of the plurality ofphysicians to thereby define ancillary medical procedures that arepreferred by the insurance network, and a second database comprisingmedical costs other than those attributed directly to medical proceduresperformed by any of the plurality of physicians to thereby defineancillary medical costs of each of the plurality of physiciansparticipating in the insurance network.
 15. Computer executable programproduct as defined in claim 13, wherein the analyzer further includescalculating means for calculating an average ancillary medical cost perphysician for the healthcare practice and identifying the at least onephysician that has ancillary medical costs that are a predeterminedpercentage greater than the average ancillary medical costs perphysician for the healthcare practice.
 16. Computer executable programproduct as defined in claim 15, further comprising an educatorresponsive to the analyzer for educating the at least one physician onbenefits of alternative ancillary medical procedures using researchliterature for comparing the alternative ancillary medical procedures tocurrent ancillary medical procedures.
 17. Computer executable programproduct as defined in claim 16, wherein the managing means furthercomprises patient intervening means for identifying at least one patientwhose present ancillary medical procedures are not preferred by theinsurance network and amending the at least one patient's presentancillary medical procedures.
 18. Computer executable program product asdefined in claim 17, wherein the management means further comprisesgenerating means for generating first and second letters, the firstletter informing the ancillary medical facility that the at least onepatient's ancillary medical procedures are amended to new ancillarymedical procedures and the second letter informing the at least onepatient that the patient's present ancillary medical procedures areamended to the new ancillary medical procedures, wherein the first andsecond letters are reviewed for accuracy, signed by the physician, andtransmitted to the respective ancillary medical facility and the atleast one patient.
 19. Computer executable program product as defined inclaim 18, wherein the management means further comprises an updater forupdating each of the plurality of physicians in the healthcare practiceof any changes in the management of ancillary medical costs that arepreferred by the insurance network.
 20. Computer executable programproduct for managing a healthcare practice including a plurality ofphysicians and participating in an insurance network, stored on atangible computer medium positioned on the server, comprising: anupdater responsive to a user interface updating each of the plurality ofphysicians in the healthcare practice of any changes in management ofmedical costs other than those attributed directly to a medicalprocedure performed directly by any of the plurality of physicians tothereby define ancillary medical costs and that are preferred by theinsurance network; recommending means responsive to the user interfacefor recommending to each of the plurality of physicians alternativemedical procedures other than those performed directly by any of theplurality of physicians to thereby define ancillary medical proceduresand that are preferred by the insurance network; an analyzer incommunication with at least one database and positioned to analyze datain the at least one database and compare ancillary medical proceduresthat are preferred by the insurance network with ancillary medical costsof the plurality of physicians participating in the insurance network tothereby identify the ancillary medical costs of the physicians that arenot preferred by the insurance network; and managing means responsive tothe analyzer for managing the ancillary medical costs of the healthcarepractice identified as not being preferred by the insurance network tothereby modify the ancillary medical costs of the physicians in thehealthcare practice to be more profitable to the insurance network, themanaging means including an identifier for identifying responsive to theanalyzer at least one of the plurality of physicians in the healthcarepractice participating in the insurance network that is at a greaterrisk of not receiving a predetermined reimbursement amount for theancillary medical costs from the insurance network by engaging inancillary medical procedures that are detrimental to receiving thepredetermined reimbursement amount for the ancillary medical costs, anda modifier responsive to the identifier for modifying ancillary medicalcosts management behavior of the at least one of the plurality ofphysicians at the greater risk regarding the ancillary medical costs,the managing means further determining responsive to the modifier thatthe risk of not receiving the predetermined reimbursement amount for theancillary medical costs from the insurance network has been reduced. 21.Computer executable program product as defined in claim 20, wherein theat least one database comprises first and second databases, the firstdatabase including the ancillary medical procedures that are morepreferred by the insurance network, the second database includingancillary medical costs of each of the plurality of physiciansparticipating in the insurance network.
 22. Computer executable programproduct as defined in claim 20, wherein the analyzer further includescalculating means for calculating an average ancillary medical cost perphysician for the healthcare practice and identifying the at least onephysician that has ancillary medical costs that are a predeterminedpercentage greater than the average ancillary medical costs perphysician for the healthcare practice.
 23. Computer executable programproduct as defined in claim 22, farther comprising an educatorresponsive to the analyzer for educating the at least one physician onbenefits of alternative ancillary medical procedures using researchliterature for comparing the alternative ancillary medical procedures tocurrent ancillary medical procedures.
 24. Computer executable programproduct as defined in claim 23, wherein the managing means furthercomprises patient intervening means for identifying at least one patientwhose present ancillary medical procedures are not preferred by theinsurance network and amending the at least one patient's presentancillary medical procedures.
 25. Computer executable program product asdefined in claim 24, wherein the management means further comprisesgenerating means for generating first and second letters, the firstletter informing a medical facility other than that attributed directlyto each of the plurality of physicians to thereby define an ancillarymedical facility that the at least one patient's ancillary medicalprocedures are amended to new ancillary medical procedure and the secondletter informing the at least one patient that the patient's presentancillary medical procedures are amended to the new ancillary medicalprocedures, wherein the first and second letters are reviewed foraccuracy, signed by the physician, and transmitted to the respectiveancillary medical facility and the at least one patient.